SUICIDAL THOUGHTS

Causes

The causes of suicidal thoughts may include a sudden, negative life event. Fantasizing about death can occur at different stages of life and may be the result of distressing events or financial problems. A person who plans to take their own life may have experienced trauma such as the death of a loved one, a serious illness in a family member or in themselves, and the loss of relationships, possessions, or self-worth. A person who wants to end their own life may experience chronic stress, see no hope for their future, be unable to cope with the emotions caused by the crisis situation, and be unable to take actions that could improve their well-being. Often, for that person, suicide seems like the only way out. Suicidal thoughts may occur in the course of mental health conditions such as:

• depression,
• bipolar disorder,
• schizophrenia,
• personality disorders (e.g. borderline personality disorder),
• eating disorders,
• addictions,
• anxiety disorders.

People who have suicidal thoughts often show self-harming behavior, take life-threatening risks, and may injure themselves, for example by displaying suicidal behavior and using various psychoactive substances.
Among the theoretical models explaining the occurrence of suicidal behavior (including suicide attempts and suicide) that emphasize the importance of suicidal thoughts, the concept of the presuicidal syndrome described by Erwin Ringel in 1953 should be mentioned. According to this theory, about 80% of suicide attempts are preceded by a specific mental state called the presuicidal syndrome, also known as a suicide crisis. This condition consists of three main, mutually reinforcing components (suicide precursors):

• narrowing of the following areas of functioning:
  – dynamic narrowing (dominated by negative feelings and thoughts, pessimism, anticipation of misery, fear, low self-esteem, feelings of helplessness, concentration on losses suffered),
  – situational narrowing (not noticing the possibility of changing one’s own situation, feeling trapped in a situation with no way out, lack of hope taking away a sense of meaning and obstructing constructive action),
  – narrowing of the value system (previously valued principles losing their value, giving up interests and contact with others),
• narrowing of interpersonal relationships (social withdrawal, loneliness, feelings of rejection);
• the buildup of aggression and tension, which are first held back and eventually turned inward, i.e. against oneself, which may lead to suicide;
• the emergence of fantasies (suicidal thoughts), in which suicide is incorrectly seen as a favorable and desirable solution.

A suicide crisis should not be attributed to one specific illness or mental disorder. It is a condition that may occur in the course of many different mental disorders. As a state of immediate danger to life, a suicide crisis requires immediate help to prevent a possible suicide attempt and to provide medical care as quickly as possible.

Treatment

The presence of suicidal thoughts indicates the need to seek medical help. Through effective treatment of the mental disorder underlying the suicidal thoughts, these thoughts can be reduced or resolved. This may include, among other things, pharmacotherapy or psychotherapy. Suicidal thoughts accompanied by the urge to act on them may be an indication for psychiatric hospitalization—it allows the patient to be provided with a higher level of safety, more intensive treatment, and more frequent adjustments to treatment.